Provider Demographics
NPI:1285077610
Name:LUKE, CAMILLE P (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CAMILLE
Middle Name:P
Last Name:LUKE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8713 GREYLAG ST
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-7030
Mailing Address - Country:US
Mailing Address - Phone:614-401-4644
Mailing Address - Fax:844-564-1402
Practice Address - Street 1:110 N HIGH ST STE 110
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-3069
Practice Address - Country:US
Practice Address - Phone:614-401-4644
Practice Address - Fax:844-564-1402
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-16
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.9542235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist